It's just that simple

ASTYM website:

http://www.performancedynamics.com/

My opinion is as thus:

Normal, healthy collagen fibers within a tendon should align with each other in parallel (think spaghetti in a pack). When a tendon is severely damaged, the body starts laying down new collagen very quickly, and as a consequence, it does not align normally (think spaghetti in a pot). This scar or misaligned collagen is weak and inflexible and very suseptable to irration and pain.

The immune system plays a *very* important role in soft tissue healing because it phagocytizes or chews up damaged tissue. Immune cells also secrete signaling molecules that stimulate tissue growth. ***With achilles tendonosis, paradoxically, after the injury progresses from the acute to the chronic stage, there is a complete dearth of immune cell involvement so the tendon gets stuck in a chronic degenerative state.***

In general, I think ASTYM re-introduces good inflammation to help the body finish healing cycles and clear out old scar tissue. Its a lot more potent than massage because the plastic instruments produce higher local pressure to physically traumatize the tendon.

The PT I worked with initially thinks the direction of force application is important and that a shearing force is created that damages collagen/scar that is not aligned with the health portion of the tendon. (This was in response to my asking why I couldn't just put on a pair of track spikes and run some hard sprints to traumatize the tendon and thereby stimulate healing). In general I agree with this. At the molecular level, I do know that there are proteases (enzymes that degrade proteins) that specifically target misaligned collagen. I suspect that ASTYM traumatizes the tendon just enough to invoke an immune reponse and activate specific proteases, etc, without *damaging* the tendon, helping it escape from its maladaptive state of quiessence.

My PT told my that for the ASTYM to work, I had to run on it because the forces the tendon is exposed during is regenerative would shape its remodeling. This is consistent with my knowledge base. I also had to stretch multiple times a day to keep the new collagen from being laid down short and tight. I suspect that the running was more important than the stretching, but I could be wrong.

After the first 2-3 treatments I wasn't so sure it was going to work. It took 4-5 treatments (2x/week) and then I could tell for sure that my tendon was getting better. After going through a few treatments, I've learned how to do on myself and got some ASTYM-like instruments off ebay and use them when I can't get over something. For me, its been a magic bullet.

Thanks for the info. I might look into some options for this type of PT in Boise. What does the instrument look like that you purchased to do it yourself?

John

John,

I got mine here:

http://guashatools.com/

I would think Boise has a few PTs that do ASTYM. I'd call any local sports medicine clinics and ask. Also, it would probably be good to go see a sports medicine doctor to get some imaging done (preferably a non-surgeon to start out with because you don't want a one-trick-poney with a trigger finger for the knife).

Sometimes with prolonged tendonitis/tendonosis, calcium deposits form, almost like little chunks of bone. I think those usually need to be surgically removed, ie Liu Xiang. I got mine imaged via ultrasound which ruled out spurs but did show a very small area of degeneration. My sports med doc was the one who told me about ASTYM and referred me to the PT.